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HomeMy WebLinkAbout0585 SANTUIT ROAD - Health --_ - - vi 585 SANT14IT POO , COTUIT 00 97 00 d Q 11/18/2020 ShowAsbuilt(1700X2800) TOWN OF BARNSTABLE LOCATION f,,/,f g J SEWAGE(f ?�-/$O Ia VILLAGE`n f.,,.f ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO.,9r3 l n ed 77r' 7!, Y SEPTIC TANK CAPACITY /port G., LEACHING FACILITY-.(type) Pad' (si=)f 00 6sr/ NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER &dl,c BUILDER OR OWNER lf4,4 sV/C' (] Qop Nr DATE PERMIT ISSUEM �-f Ss DATE COMPLIANCE ISSUED• r• 1 -)f 5 VARIANCE GRANTED- Yes No O i 1C sys, n }1r cl I https://itsq Idb.tovvn.barnstable.ma.us:8431/H ome/ShowAsbuiIt?mp=007006&sq=1 i 1/1 TOWN OF BARNSTABLE LOCATION ,���-lta 7 � SEWAGE # F C— lA 9 VT-LLAGE C, ,o j U ,+� ASSESSOR'S MAP LOT INSTALLER'S-NAME & PHONE NO. /� � G��•-� .-a SEPTIC TANK CAPACITY LEACHING FACILITYAtype) C/l s .J,_a 5 (size) L&el-, / NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ur UILDE w OR O WNER�� DATE PERMIT ISSUED: DATE . COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No Y . ,. , , .; t ,' o��`` ,y a �' I it Q' 2 --S` V f� ���� ������� �� No------------••........_ Fas... ......G=.... THE COMMONWEALTH OF MASSACHUSETTS BOARDgFME11LTH .- .. V ,gyp lirtttiun fur Biupuuttl Works Taustrurfiun liPrmi# Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: ........ ....__� .....L .. ..... T....��___________________ 1L.T.... ..._.:.. est.............. © Location-�ldc ...... ------•. . ..__._.... . ......-•--------.._...--•---...._........ . Lot•xo......._.... .......-------........... W Owner Address a .........:......•---•-•-••......._.._..•-------••-•--........-- --........----•......_-...._..------•---•-•••-----........---:......_....... ............. Installer Address - Type of Building Size Lot._.__. ' Sq. feet .. Dwelling—No. of Bedrooms___......... ��2 Expansion Attic ( ). Garb. e.Grinder ( ) a"4 Other—Type of Building ......... No. of persons............................ Showers YP g ..................... p ( ) — Cafeteria ( ) Other fixtures .....................................A57F Design Flow.... ......�.l_Q.._......-- gallons per ms �r day. Total it lPow........... .. Septic Tank—Liquid capacity.l gallons Length] _.b_... Width._ _... ..-. Diameter:............... Depth._ .._... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No....... . Diameter......IQ...... Depth below inlet......6G ........ Total leaching area5_5_.�-_Qsq. ft. Z Other Distribution box Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date._______________.................._...-. Test .Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs. Test Pit No. 2.___ ._minutes per inch Depth of Test Pit................... Dep�tround 4er .-.____ ..-.. aA --T-� c ..:. Descriptionof Soil........ ............................................................................................................................. U .................... ___------- •------•----•-- ---------•-•....................... _......... _-_____----------------- __---------------- •--------- •------- .........._ -•--- --••---------------------------------...-------......----•------...-------------•-•---•---••-------•--._..._..----------------=-----....-•----...---........---••-•--•--....._•--••-----•=----.......... V Nature of Rt irs or Alterations—Answer when applicable ........ .... . „!._- .... . Agreement: � L� The undersigned'agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:ITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operati ntil Certifi tt of Co iance has been issued by the board of health. Signed. /'/ `=. ..�1 f`, p . - -- Date c Application Appro �d By.............. ....................---•-•-•--•......._.... ::Z- -���G7 Da Application Disapproved for the following reasons...-:..........:....................•---------._..........----........--------•---........._................._.... .............•--•---.............-------......._.....------......._......----•--..........::......._....-.-----.._....._........_.........-•----•••........---._...•-••••-----.....---....... ........ Date PermitNo............................................_...... Issued_-----.................................................. r Date Cc, No...?). _,C1 Fimz A ............. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4Js. ..................OF.....................4............................................................... Appliration for Bispaiial Works Tonstrurtion Vernfit Application is hereby made for a Permit to Construct or Repair -an Individual Sewage Disposal, System at: L-G) —T (-I <_�A�TTJJjC)Tl-( I -F ................... ..................................................... ..... .................1------- I Location-Address or Lot No. I................................................................................... Owner Address ..............................................in ................................................... ... ............................................................................................. staller Address Type of Building Size Lot... . �Sq- feet U ..... Dwelling—No. of Bedrooms................_.._..__._......._.....___..Expansion Attic Garbage Grinder .-I 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures .....................................La"j��...................................................................................................... 45 day. Total daily;flow.._....._...................................gallons. Design Flow._......_.I.I.r.2.....................gallons per,person per Septic Tank—Liquid capacity.!.(A_ 0�mllons Length..It k... Widthj�-'.?'A..... Diameter............... Depth��' 11 Width; I .......... Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit ..... Diameter__._.ti.Q...... Depth below inlet_..._. ......... Total leaching area- .4:._(]sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.............................................................................Date..........._........_........_....__.__. Test Pit No. I................minutes per inch Depth of Test Pit..____._...___.._... Depth to ground water.._._._........._.__.... 44 Test Pit No. 2....... ..minutes per inch Depth of Test Pit.....................Depth to ground water...___........_.....___. . ..... ........ ................. 0 T\ `4 U V�, Description 6f Soil............... ............................................................................................................................................... ...........**-------*-------------*----------------------------------*­"........**---------­*-------­­------------------------------------------------ ------ ------- ....................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable______________________ ....... ...............I....... ------------------- .................................... ................;;........... Lk .............................. . . ---------------.... .....S...........I................ Agreement: V The undersigned agrees to install the aforedescribed lndividuli §ewage Disposal System in accordance with the provisions of TAI TILE 1 5 of the State Sanitary Code— The ullidersigned further. 'agrees not to place the system in operation:utitil=�a-,Certificate_of Compliance has been issued by the board of health.' /,;7/ t Sighed.-................................................................................. ............. ........... ..... Da e/Application Approved By................ ........ __ ........... Application Disapproved for the following reasonstj..................................................................................... Date, .......... .. .. ........... ......................................................................................................................................................................................................... Date PermitNo........................................................ Issued..........._ ......................................... Date THE COMMONWEALTH OF MASSACHUSETTS w. BOARD .OF. HEALTH ks, eAVIIJ - 4��-:�j A,&( ..........................................OF................................................................0.................... jV.,01V (Irrfifirate of Tontpliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by,**..... ................*...L..**"' .I. I.... . .........W....A....q........................... A-1�.f CFI j c.. ..................................... 'Installer at.... O ...... .................. S t V4 , ...................................................2 ...............O . ., ( has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the Zapplication for Disposal Works Construction Permit No.......................................... dated_...._:..:'....:?.............................. i i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................;.................................. Inspector.....:77 .............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... No......................... FEF........................ Disposal 1yorkii Tonstrur#ion famit Permission is hereby granted............... ......I..........u...2:>......... to'Construct or Repair O an Individual Sewage Disposal/System C --,-4 atNo.........................LtA....LA.................................................................................................................................................... Street rd 6- I-Z q 16 as shown on the application for Disp6gail Works Construction Permit No_______________ ___ Dated..__17....!.�... 6 ... ................ ........................................... Board of Health ........ ...... ......................................... DATE........... TOWN OF L?ARNSTABLE LOCATION S"���� f R,_ SEWAGE # / 8�0 'A VI:'LLAGE ���c,..� ASSESSOR'S MAP Q LOT INSTALLER'S NAME & PHONE NO.&t �a c y 77S �Io:L G 5/ SEPTIC TANK CAPACITY lDOy Gu .LEACHING FACILITY:(type) (size) `od 4-c NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER �t,c BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE!GRANTED: Yes No �� 1 13 o 10 S'�5 :ti F Poord of He-olth- To,,-irn Of Barnstable ny QQ P.O. Box 534 Hyannis, Massachus,,fis 02,^ FEB .................. 1 01 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF......................................................................................... Appliration for Disposal Works Tonstrurtion rumit Application is hereby made for a Permit to Construct (bl) or Repair an Individual Sewage Disposal System at: i............................. C-?)T 0 N7 . ........... .................................................................................................. Location-Address or Lot No. ............0..1.0, ................................ .................................................................................................. ...................... K13 - Owner Address .................................................. - .c;.o........ ...... ....... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.__.....I..................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) 04 Other fixtures ...................................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid*capacity.............gallons Length---------------- Width________________ Diameter..._............ Depth__---__--___-_-. W x Disposal Trench—No. .................... Width.................... Total Length__.................. Total leaching area....................sq. ft. > Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by........................................................... .............. Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.._................. Depth to ground water........_..._....._._._.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-..--_--__-_-__---___-.Ri ......................................................................................................................................................*------ 0 Description of Soil........................................................................................................................................................................ U ......................................................................................................................................................................................................... ................................................. ................................................................................................... ..............................I.................... U Nature of Repairs or Alterations—Answer when applicable.7WTP. -0---------I ---TA.tj.;k...... n•.---- �,-o 0 ........................ ............................ A.0 C-C,,V—P.-t,.A*V—F— Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL!'I 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. 44 .1. 1, . . .I.... - Date 40 420, ................ ..........Application Approved By.............. _j---------------*------------------ Date Application Disapproved for the following reasons:............................................................................................................... ........................................................................................................................................................................................................ Date Permit No---------- Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I &�CCL� M / \ ' �VL DATA -01 No.. -.�Pl(�.. Fes$... .��...._........_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................... ..OF.......................................................................................... \V_ Appliratinn for UWVviiaal Wnrkn Tamtrnrttnn Famit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal (� System at: ,;- 6 i S ( na U 1 -� � 7 [cJ"v, ................_................................................................................ ••--•....---•-------•-•-•-•-------•-------......••... --•------------•--••-•------------•-------. Location Address or Lot No. ( • I, Owner �^ Address t_f r'© *J, c) �{ s� W t f ,U i f j Installer Address t Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........l...................................Expansion Attic ( ) Garbage Grinder ( ) Other—' Type of Building No. of persons............................ Showers � YP g •-••--•--•-----•----.•.-•--- P ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area___.-_-_--•_.-------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--__...._-.-_-_____--.-. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---____-_____-_----.-.-- -----------------------------------•----•----------•------.........----------•................------................_......................... •-------------- ODescription of Soil......................................................................•---•-------------------------------------------------------------...._.----................... X V ...................................................•••--•-•-•----------•-----•••-........•-•...--••--••....-•----•-------------------••--•---•-•------•...-••---•......--•..........-----••------•------ W •----------•-------------------•-•--•-•••-•---•---------------------------------•------•----------------------------------------------•----------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable.11 a'.'..{ -� f i- - ------------ ---------------......................................................... t_.. ,JC', ":" . - !.ar- C ",F �. - F . .Z• ...7t... A?D .... +-'.. ..c L•. �.I� l,fi6�.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITS y g g p y of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................•----•--••---•--•--•--•---•-----------------....------------•-----. ................................ (� Date Application Approved By............... ------- ' = --.-----••----- "_ .i �1...`. Date r Application Disapproved for the f ollowi'ng"��ons------------------------------------ I - Date _ . --------------•--._.....--•-----------•--••------�....-----•--•----•----------..............------•--•.__....._....__-•-------------•-•----------'..---•-----•-------..._......_Date f 1 , s . Pe mtt No.-------•------....^- ................... Issued_...................................................... Date t THE COMMONWEALTH OF MASSACHUSETTS - 1 BOARD OF HEALTH 4. ..............OF............11... r........:.- - .� ? ............................... r_ Trrtifiratr of Tnntpliatt ae THIS IS"TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired C>4 by----------------- T....------• --.......----------•----------••-----------••---.....---..... - staller .. "� at.----------•----.-•--J--....... <!�t= ------- t.<9. . has been installed in accordance with the provisions of TITIE of,�,46 State Sanitary Code as described in the application for Disposal Works Construction Permit-1To - C.-v'. ...... dated-.............. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................... a.Z--c- ..cy...........---------------- Inspector................... -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q'G tI l / O .........'.. l Cf1-._.......OF.......U�e � `a�......: ��^ No.. .. '......... FEE...................... .. . EltynsFal Vorkii Tnnntrnrtinat aeranit Permission is hereby granted. / -- �--.. �.. to Construct ) or Repair ( ) an I ivid al Sewag Disposal S s em �. at No - - Street as shown on the application for Disposal Works Construction Permit No. _� lJ... Dated.......................................... ................................9_= Board of Health 6 DATE_--------------- -----'-�---^�--------�-•- ..----•----•--..__........- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS _�— COMMONWEAUl'II OF MASSACILUSE'I"I'S _ — EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA g -- DEPARTMENT OF ENVDIONMENTAL. PRO'I'EC ® 8 =. ONE WINTER STREET, BOSTON MA 02109 (617) 292-5500 d® r #415a TRU OXF, 350 MAIN STREET IVA 199 etary ARGEO PAUL CELLUCCI WEST YARMOUTH, MA '�Y 9 Governorran DAV1D B. RUBS 508-775-2800 Co`rai ssioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Zr PART A CERTIFICATION MAP 007 PAR 006 REPORT 2 OF 2 PROPERTY ADDRESS: 585 SANTUIT ROAD, COTUIT ADDRESS OF OWNER: DATE OF INSPECTION: AUGUST 12,.1999 HARRY SINDEN NAME OF INSPECTOR : JAMES D. SEARS I arri.a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of Inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(30) days of completing this Inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,If applicable and the approving authority. NOTES AND COMMENTS: SYSTEM GARAGE AND ONE BEDROOM REPORT 2 OF 2 SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IIS NO GUARANTEE ON THE LIFE OF THE SYSTEM. revised 9/2/98 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 585 SANTUIT ROAD,COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: YES 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The System,upon completion of the replacement or repair,as approved by the Board of Health will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance,(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: r- The system has aseptic tank and soil absorption system(SAS)and the SAS is within ' 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm. Method used to determine distance _ (approximation not valid). 3) OTHER I revised 9/2/98 3 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 D]SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to Determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than'%day flow T- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 4 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 585 SANTUIT ROAD,COTUIT . Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A: X r The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X System components,including the Soil Absorption System,have been located on the site X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site, Has been determined based on: X Existing information. Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)J X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 y 5 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 585 SANTUIT ROAD,COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 FLOW CONDITIONS RESIDENTIAL: YES Design Flow: 100 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 1 Number of bedrooms(actual): _ 1 Total DESIGN flow Number of current residents: 0 Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): N/A If yes,separate inspection required Laundry system inspected(yes or no): N/A Seasonal use(yes or no) YES Water meter readings,if available(last two(2)year usage(gpd): Sump Pump(yes or no): NO Last date of occupancy: N/A COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow: Gpd(Based on 16.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information:N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy _. Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known)and source of information: 1989 PERMIT#89-180A Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: YES (Locate on site plan) Depth below grade: 32" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000-GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: V Distance from top of scum to top of outlet tee or baffle: 11" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How dimensions were determined TAPE&ASBUILT Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) TANK AT WORKING LEVEL,OUTLET BAFFLE _ TANK&COVER 32"BELOW GRADE GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction _ concrete _ metal Fiberglass _ Polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakag@,etc.) revised 9/2/98 7 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 TIGHT OR HOLDING TANK:N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass Polyethylene other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Yes; No Date of previous pumping:" Comments: (condition of inlet tee,condition of alarm and Float switches,etc.) DISTRIBUTION BOX: YES (locate on site plan) Depth of liquid level above outlet invert: NO Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D BOX NOTED ON ASBUILT,DID NOT LOCATE OR DIG UP BOX OVER T BELOW GRADE PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 8 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 SOIL ABSORPTION SYSTEM (SAS): YES (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: 1 Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overfjow cesspool,number, Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) ONE 600-GALLON PRE CAST PIT,DID NOT OPEN AS PIT IN STONE DRIVEWAY AND OVER FOUR PLUS FEET BELOW GRADE CESSPOOLS: N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure,,level of ponding,condition of vegetation,etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) i revised 9/2/98 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locale where public water supply comes into house) �3 0 r 3° F�oNf . 0 revised 9/2/98 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to no groundwater 11 Feet Please indicate all the methods used to determine High Groundwater Elevation: X Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) GROUND WATER DEPT TAKEN OFF PLAN revised 9/2/98 11 COMMON WEALTH OF MASSACHUSETTS _ - EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIO ONE WINTER STREET, BOSTON MA 02108 (617) 292-5.500 f TRUDY OXF, 350 MAIN STREET �' y® Secretary ARGEO PAUL CELLUCCI WEST YARMOUTH%ra , MA VID B. sT I GovernoruHs _ _ 508 775 2800 - . . . NQP1 Comr ssioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A CERTIFICATION MAP 007 PAR 006 REPORT 1 OF 2 PROPERTY-ADDRESS: 585 SANTUIT ROAD, COTUIT ADDRESS OF OWNER: DATE OF INSPECTION: AUGUST 12, 1999 HARRY SINDEN NAME OF INSPECTOR : JAMES D. SEARS I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function.and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS q INSPECTORS SIGNATURE: yLze► p. DATE: The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. NOTES AND COMMENTS: SYSTEM MAIN HOUSE REPORT 1 OF 2 SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF'THE SYSTEM. revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: YES I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: NIA One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The System,upon completion of the replacement or repair,as approved by the Board of Health will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled,or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ' r revised 9/2/98 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 D]SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to Determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than'%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater . elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. f revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system Has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X System components,including the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site Has been determined based on: X Existing information. Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)(15.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 FLOW CONDITIONS RESIDENTIAL: YES Design flow: 440 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 4 Number of bedrooms(actual): 4 Total DESIGN flow Number of current residents: 2 Garbage grinder(yes or no): YES Laundry(separate system) (yes or no): N/A If yes,separate inspection required Laundry system inspected(yes or no): N/A Seasonal use(yes or no) YES Water meter readings,if available(last two(2)year usage(gpd): 1996-97192,000/1997-98 126,000 Sump Pump(yes or no): NO Last date of occupancy: N/A COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow: Gpd(Based on 16.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic tank/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed d (if known)and source of information: 1986 PERMIT#86 1298 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: YES (Locate on site plan) Depth below grade: 5' Material of construction X concrete _ metal _ Fiberglass Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,500-GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: N/A NOTE:OUTLET COVER 5'BELOW GRADE Distance from bottom of scum to bottom of outlet tee or baffle: N/A How dimensions were determined AS BUILT&TAPE Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) TANK AT WORKING LEVEL,INLET TEE TANK 5'BELOW GRADE INLET COVER 8"BELOW GRADE ` GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) revised 9/2/98 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 TIGHT OR HOLDING TANK:N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Yes; No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: N/A (locate on site plan) Depth of liquid level above outlet invert: N/A Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) PUMP CHAMBER: N/A (locate on site plan) Pumps in working order::(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 SOIL ABSORPTION SYSTEM (SAS): YES (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: Leaching chambers,number: 5 Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS 5 GALLEYS,GALLEYS T BELOW GRADE COVER T BELOW GRADE 2"WATER, NO HIGH WATER MARK OR OVERLOADING SEEN CESSPOOLS: N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure,,level of ponding,condition of vegetation,etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) revised 9/2/98 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SIDEN Date of Inspection: AUGUST 12, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) !9 19' �f e"r I revised 9/2/98 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 585 SANTUIT ROAD, COTUIT Owner: HARRY SINDEN Date of Inspection: AUGUST 12, 1999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to no groundwater 11 Feet Please indicate all the methods used to determine High Groundwater Elevation: X Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) GROUND WATER DEPTH TAKEN OFF PLAN NO WATER 4' BELOW LEACHING revised 9/2/98 11 No .0-3••--- Fa�.�rc� ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH �..........OF......... ..... .... .. .. Applira4ion -for Ditivuiittl 19orko C owdrurti n Vamit Application is hereby made for a Permit to Construct (11,11or Repair ) n Individual Sewage gisposal Syst t: -��' �/ #� K7------------------------------------------- --- oft-Address or Lot No. •••. .••• . • • . ................................. ............................. -------••--•........................•••.. O e Address W ^" Installer Address T pe of Buildi Size Lot----------------------------Sq. feet U Dwelling-rNo. of Bedrooms--------------- -----------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons..........------------------ Showers ( ) — Cafeteria ( ) a' Other fixtures ------ Design Flow...........:... C� .............gallons per person per day. Total daily flow___--____ --_ ........ gallons. W g P P P Y Y g< WSeptic Tank'—Liquid capacity allons Length................ Width............ . Diameter---------------- Depth.-..--_-_-..-.- x Disposal Trench—No. .................... Width.__-.._.., Tot e tgth__ Total leaching area--------------------sq. ft. Seepage Pit No... J Diamet `�.� 7ee e ow to et..............°_.._ Total le hin area-_-_-_...._..._.sq. tt. { �+' � ' Ftn j�f g,� z Other Distribution box ( ) Dosing tank ( ) /` G/fit.. Percolation Test Results Performed by---- ---- T -------------------------------------- Date Test Pit No. 1----------------minutes per inch Depth of est it-------------------- Depth to ground water-----------.-_----.-___. f= Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.----.---..--.-_.-_._. ------•.... ---- Description of Soil_._______________________ ' - = -- --- ----------�' e V -••---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W -••-------••---- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------- ------- UNature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------------------------- --------------------------------------------------- ---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by tl��ar=eal . igned.- ------•----•-- ................................ Date Application Approved BY ./7K- Application Disapproved for the following reasons------------------ --------------------------------------....••---.........-•--•--•----. •----------------------------------------------------------------------------------•-------------------•---•-•----••-••--.....--•--•----••-------•---------••...-----•----------------...--------•••-••- Date PermitNo......................................................... Issued........................................................ Date Fas... :- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH r..........OF_..._..................... .. Appliratinn -for Bhipoii tl Workii Tomitrnrtion Prrntit Application is hereby made for a Permit to Construct (�) or Repair wi ) n Individual Sewage DiS osal st -IS •--... ... •. -------•F •---- •. . ---• .............. ......... .-'----- ---.....------------------------••....... L atio A ess or Lot No. -------------------------------------------- -----•--------- Own Address a .............. . ... • • . ...... � In a ler Address d Type o Buildi g Size Lot----------------------------Sq. feet Dwelling Ao. of Bedrooms.-------- -------------------------Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ............................ No. of persons. ---__.--_--______--__--_- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------ d r-,� ----------------------- W Design Flow..................lJ_--...._..--• allon§,Rer person per day. Total daily flow............................................gallons. WSeptic Tank�—Liquid capacity1!/.�kgallons Length---------------- Width................ Diameter-..__.---------- Depth....---_-.----- x Disposal Trench—No..................... Width----------- ,� Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.----/------------- Diameter.AmV. /Depth below inlet____--_.___-..-. -- Total leaching area----.-------------sq. ft. z Other Distribution box ) Dosing tank ( ) '-, Percolation Test Results Performed by------ ------------------ ------------------------------------------------ Date........................................ a Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water-.--.._-.-------.--,- GZ, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.---_.---.-_-.---_-. ----------- - - - - ---- D Description of Soil- - ----- _ --- --- "�' - ------ - ---------- ------ ---- V ..............................................--- •--- ----------------------------------------------------------------------------------------------------------------------------------------------- W ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ----------------------------------------- . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance.has been issued by ..* � �t�h�✓edr�bt'o�ard of> �h�eva� ,Signe&. .. � 6i � u � _ DD�aatteAPPlication Approved BY----' --- e � f. Application-Disapproved for the following reasons-------- --------------•--•---•-- -------------------------------------------------- ------------------- ..•••---••••-----•--••-•-•--•----•-----------•---------------------•---••---••---•---•-......-•--••-••-••..----•-•--••----•-•-------•---•-•-•---•--••-----------•-----------------------------•-•-------- Date PermitNo......................................................... Issued........................................................ Date y THE COMMONWEALTH OF. MASSACHUSETTS BOARD OF HEALTH i ..............OF.......... . ....... ''! f (9rrtif iratr of fhnntpliatta THIS �S TO CE PTIFY tat- the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--— ---- M - y ✓ �/ Inst� er atl �'�'s !--- ----- 4- -------------`--------------------•-------------------------•--.---------- has een installed in accordance with the�sions of Articl XI of The State Sanitary Code 's desc 'bed in the P , application for Disposal Works Construction Permit No....._ ��_:- -___-___•-_.-_.- dated'...., * ___.-_----�_�_.---•------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.9---------------••--•---•----•--•--•-•-----••----•-•----•---••---.....•••..---•-- THE COMMONWEALTH OF MASSACHUSETTS /I e BOARD OF HEALTH, C�-tea .....�Gi "".g/'✓ ... ..OF.........1 .... ..!+� r'...._ .... , No....... ..... FEE., : Dinpoaal Warkii C11.1 fitr libit Vrrmit Permissio i ,hereby granted_.. _ . !-. �;, to Coat No.nstr t ) or Repair (^ ) an "dua Sew ge Disposal System Street as shown on the application for Disposal Works Construction PeRmit N am^ :.^+.... Dated':_ __ _. ... Board DATE. of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS cq- 5sni t 44. w l t VJ i F-i 4 i 7a. . _ L � - _ . . ., � 2 l � . � �f � - � � y. . . . �� . . �, �• r _ � , e �' _�. ,'� . - - � i ifs + - - .. f t '. - 't. y A - _ .. - .. i (� i Z tee• f' a,: .. 777— SECTION. SEW ,.. AGE. V ... .,.. ,...:«. .,.. :, r_ .. . ...... .... M•. - air. SEPTIC TANK - _ "D"BOX - I LEACH TOP OF FON I l i l h i ..2..OF"I TO y,.. WASHEO STONE �. xis•---r►N _ i __ OUT• IN• �C� �,e' ��/ f / (( L� Q G ►N• OUT- 0 �I ISTI tj SEPTIC +�' o q �/ , �✓ r j '` 'i f i �7 TANK 1�,/ O3 / EL-ELE C B� D ELEV. ELEV. ELEV. 6 rq X z (Top OF PIPE, � Ir✓ 11.(C1 ELEV. - ELEV. SrnL TAN K r WITH I SOO N �/A 1.t.f>I�I "CAP/L I 1. OF 3A"-L%" UNJ T: WASHED STONE /' ." Irc�PoSab Ior TEST HOLE LOGS o, /'' / k%►� 3 TDA'�,�G C?F 4 RLpI.-1 a TEST BY (,E/�cGl-(-I. WITNESS G TEST DATE DESIGN BEDROOM HOUSE i' O / �- � � % /,,� ,p.,• •, �` , /_ _aG ELEV. 2 ELEV. ` �. /�F NO PERC RATE 'GZ MINAN. .-. DISPOSER DISPO R FLOW RATE I 10 . (GAL✓DAY)� O 2® - SEPTIC TANK SSO REQ'D SEPTIC TANK SIZE LEACH FACILITY WALL`t� � (Z.S� ) _ G/D-. BOTTOM __zlo " )b �COQ._( (•0 ) _ _�CvO _ G/D. TOTAL97 �✓- � �� \� C !aC USE: 5- s A 5 \ / 'F�-�t� T LEACHING �a U�Y -WATER ENCOUNTERED - _ / i. . : T . � r NOTES: (UNLESS OTHERWISE NOTED) � ;; NOTE t o of 1.DATUM(MSL) TAKEN FROM �1�t1T_..____QUADRANGLE MAP -r is 6 LoSc2_' 2.MUNICIPAL WATER Ida _ AVAILABLE T A TO p2�,� 3.PIPE PITCH:W"PER FOOT II`' 1� �d 1 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO• - IQ qq 5_MIDI.GROUND COVER OVER ALL SEWAGE FACILITIES:;1!FT• -" ----DISTANCE AS CERTIFIED 6.PIPE JOINTS SHALL BE MADE WATER TIGHT Eg 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. O� �nyG j a a? (� STATE ENVIRONMENTAL CODE TITLES c / ARNE.H. i _ r " s �• �` SITE' PLAN .0 LOCUS II. • / 1 qgQQpp ENGINEER I �� �f+ s9�y GO1'UI T � 4rzLIsT�P� l FSS/pHl:t,EyC�W o� 'ARNE REF: �.C.fvES�..OgS a.P -I I; _ o t�>u F �/ . . * - �dOW CQpL' glftoC'�Y/� PREPARED FOR: OIL L1 CIVIL ENGINEERS BOARD OFIiEALTHLN CONTOURS. (EXISTING)' ,.1 L� 41 9.�MZIA St. Q� R OR: k (PROPOSED)-0-0-0�0- APPROVED DATE ���'y �r MA Yypyq�� rR - SCALE AL �O DA �r3 P>4l A. i/Z�:ZZ�. •fn" vim' . ." e,,x ,. _...... - ...• .. r ..--. .. '. ,..:. ... __ .-.r ..� ..#. .... a .. --. .. � mow; yi+ F MASHPEE ROAD a Q ;0 >v n NOTE: BUILDING FOOTPRINT EXPANSIONAREA WITHIN HE FIFTY FOOT COASTAL BANK (T.O.) BUFFER 4 ��� � N ZONE = 39 S.F. Q- QO z NE R\oG�RO a p� TOP OF COASTAL Q BANK - STATE U) t ! < GENERAL NOTES: / TOP OF COASTAL 1 tt 1 I 1 CB/DH BANK - TOB o ASSESSORS DATA: t t t FND z MAP 7 PARCEL 6 i t `/ (i tt ^` l /l ' 21.1790 r 2161t RECpRp REFERENCE DEED: 12560-267 F z I I ( I ( I I 1�' 5�.1% cb p�AN 19 143 LOT AREA - 21,262f S.F. TO MHW �O,q T 4� 4L - I I I ( t 18. % N ! I i S7 ! BM: C /DH FND. i i I I I f I t w ^ M I ! , c I o 39 10" REFERENCE PLANS: 1 ! I J r ♦ / 1 11216�, E 19-143, 257-28 & 230-85 FXI SnNG ooc �� t (C) I \\ 1\ \ ; 19. % N ♦ 17.1 ^ / ) I I �� �I'/ k I J \ \ ZONING DISTRICT: RF 4 I °Q , \ \ ~•+ r` 3 / I - MIN. LOT AREA - 87120 S.F. (RPOD) LOT 14 +40.4 MIN. LOT FRONTAGE - 150 ( ! / i MAX. BUILDING HEIGHT - 30' OR Q / � fo / ��J 1 T'` �_ 1 i 2-1/2 STORIES WHICHEVER IS DECK / i �,. J i � � � ,�l � � i / , LESSER. / / a� a J '7�� / / > BUILDING SETBACKS: v J / l / / FRONT - 30' TIMBER LANDINGS / , `- STAIRS AND DECK PROPOSED SIDE & REAR - 15' / / / / / r/ / L� I /� 1 t WAL{ i ; I J i OVERLAY DISTRICT: c-4- RPOD, MA ESTUARY & AP EXISTING t / o o i s� // // ///! / �`b/ / � "a DWELLING If U w 38• E �� a� �'`� SEPTIC COMPONENTS SHOWN PER 0 \ 4 - 'o Q / / � �, / / / ry A a E o �, � 2�, ; � AS-BUILT CARD AND OWNER INFO. z NF a Irv // ! ' �o' �? 1 IV -�40.1 i ,� �, ' q / / / / / / / 'ry h PROP SED / i o f' i FEMA FLOOD ZONE: AE (12 ) & X EXISTING PORCH 1 , MAP: 25001 CO752J / co / / i ^/ cy /. / AND STEPS / ADDI ON //o / ,�`j°,yF �`Y' / <` `�L :_ � ; v� i / ; MAP EFF.DATE: 07/16/14 00 '', ;� �` PLAN VERTICAL DATUM: NAVD1988 7,0 �cP; i �QQ a/ EXISTING NO i i 2 ii GAR. WALKn7 ► i 1 ✓ / o i WETLAND CONSULTANT: �Q q % I �o ARLENE WILSON 2`" 02 ! 152y l , Spti A.M. WILSON ASSOCIATES, INC �, o U / ',' �/ q ORS /� o~ ^� `� „� �o``��,� .,�` Atk 40 /o / qSp 20 RASCALLY RABBIT ROAD 2�p '���� � '� ? FXn/�F'��T � MARSTONS MILLS, MA 02648 FOoR o� WALKWAY` ,�� •`� / S ROPQS S/p�V ` 508 420-9792 A� `� REALIGNMENT qN _,- -- I \ I ) ` l Rq/N 19,y ` CR�sti' ' /i WETLAND PERMIT PLAN �3 /A� PREPARED FOR PLAN LEGEND: 50' COASTAL BANK Q ,� �` % 585 SANTU IT ROAD BUFFER - TOB Q�o0_12 a i +39.1 EXI5TING SPOT GRADE � / , COTUIT-BARNSTABLE> MA UTILITY POLE SCALE: 1" = 20' DATE: OCTOBER 1, 2020 O 0 20 40 - - - 24 EXISTING CONTOUR / � Feet +39.2 "'(, DWI) PROPOSED DRYWELL REVISIONS: ® S rEF,,s��e 11/22/20 REVISE SYSTEM AS-BUILT STF_PHEP REPORTED GAS LINE J. A DOYLE cn p w- REPORTED WATERLINE NO. 37559 p Stephen Doyle & Associates ® 9 P. 0. Box 621 East Falmouth Massachusetts 02536 Telephone: 508 540-2534 sjdsurvey@aol.com